In Vitro Fertilisation (IVF)
In vitro fertilization (IVF), the main treatment for infertility, allows for higher rates of pregnancy than natural conception.
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In Vitro Fertilization (IVF) is a technique whereby egg fertilization takes place outside the woman’s body. Embryos are created in the laboratory and then placed in the woman’s uterus to stimulate development and achieve pregnancy. This process involves several steps which need to be adequately coordinated. Designing made-to-measure treatment for the patient's needs, team quality and the clinic's technology are key to success.
Every patient is a unique individual. For this reason, our treatments at Bernabéu Institute are tailored to every one of our patients. Our goal is to locate the source of infertility among couples and select the most effective treatment. The male’s sperm and hormone levels are analyzed and, if necessary, a urological assessment is performed.
In the case of women, their cervical canal and endometrial cavity are examined, as well as possible alterations in their fallopian tubes and their menstrual cycle patterns. These are accompanied by detailed assessments of the couple’s sexual health.
This process ensures that IVF is the correct solution to the patients’ infertility problems and that they are physically and psychologically ready to begin the cycle. If this is not the case, the patients are offered other treatment options.
In order to maximise the possibility of pregnancy, we need to obtain more than one oocyte, which is the number a woman’s ovary normally produces.
In order to stimulate production of several oocytes and guarantee their quality, we administer a combination of pharmaceutical drugs. Response is monitored using vaginal ultrasound scans and timely blood analyses: ovulation induction.
The whole process lasts approximately between 8 and 12 days, depending on each case. The treatment can be cancelled if a low or exaggerated ovarian response is observed.
Once the oocytes are mature, we retrieve them with the guidance of a vaginal ultrasound scan under local anaesthesia and light sedation so that it is a completely painless. This process only takes 15 minutes and does not require an operation, being hospitalised, stitches or the use of general anaesthesia.
The retrieved eggs are taken into the IVF laboratory where they are prepared for insemination.
Oocytes and spermatozoids are placed together for several hours within an incubator which provides the ideal conditions for fertilisation to take place and the subsequent development of pre-embryos. The number of fertilised eggs will not be known until the next day
ICSI (Intracytoplasmic Sperm Injection)
ICSI is performed on oocytes when the reproduction biologist in charge deems it necessary or when it has been previously agreed upon.
The Intracytoplasmic Sperm Injection (ICSI), consists in the introduction of a single spermatozoid inside a mature egg to achieved fecundation.
ICSI proved to be a revolution in assisted reproduction techniques, as it overcomes most male infertility problems. This technique is used in fertilization when sperm suffers from low count, an abnormal morphology, poor motility or when the sperm is unable to fertilize through IVF. It can also be used with patients suffering from a blocked sperm duct. In this case, a puncture is made in order to extract sperm directly from the testicles.
This procedure is performed using a microscope. Micromanipulation equipment is also used, allowing us to stabilize the egg softly and subsequently place the sperm inside it. Sperm selection is essentially guided by morphological features, although other methods (MACS, IMSI, PICSI) can also be used. More information.
After fertilization, embryos start to develop in incubators in a culturing environment that provides them with everything they need in order to grow. They are watched daily, and both embryo cleavage (the number of cells) and important data about their morphology are recorded.
The embryo culture stage can last between two and five days. This enables us to observe the embryo development in order to select the ones with the highest quality. Nature will reject the weaker ones. In general, during a longer culture period, there are fewer viable embryos but they are of much better quality than the embryos achieved during a short culture period.
Embryo quality is determined by a combination of cleavage and morphology. Every embryo faces a different fate. Some have good quality, others become blocked and others make it to the end despite their bad quality. From the way they evolve we propose either short cultures (2-3 days) or long cultures (4-5 days: blastocyst).
Embryo transfer is normally scheduled between two and five days after fertilization (i.e. at the peak of the treatment). The goal is to move the embryo from the laboratory to its final destination for development: the future mother’s uterus.
It is carried out with the help of an abdominal ultrasound in order to find the perfect spot for implantation. A thin catheter is introduced through the neck of the uterus, and a drop taken from the culturing environment where the embryo is floating is poured into the uterus.
Sedation is not necessary, it is not painful and, as a matter of fact, it is very similar to a regular gynecological checkup. The procedure is performed at a temperature of 36ºC in a dimly lit, sterilized room located next to the laboratory to make it as unintrusive as possible. The remaining good-quality embryos are vitrified for future use.
A pregnancy test is scheduled 13 to 14 days after starting to take progesterone to confirm pregnancy or not: it is determined by the blood levels of a hormone named beta-hCG. This hormone produces the embryo and is transferred to the mother through placenta.
It is the first sign of the embryo and can be measured as proof of development.
In case of failed pregnancy, every member of the human team that participated begins to examine the whole treatment so as to evaluate the causes. Afterwards, a meeting with the couple is arranged to provide a medical report.
The main advantages are:
- Much less medication is needed and unlike the classic protocols, not all medication has to be injected.
- Fewer visits to the clinic are required.
- It produces less discomfort and side effects from ovarian stimulation as it is a lot gentler.
It is indicated for:
- Women under 35 years of age with good ovary reserve and good prognosis.
- Previous exaggerated ovarian response that should be avoided.
- Patients at risk of ovarian hyperstimulation.
FIV is a highly flexible procedure. It is possible to use the patient’s eggs or a donor’s. Likewise, it is possible to use your partner’s sperm or a donor’s. This technique has made it possible for women without a partner or with a same-sex partner (Reception of Oocytes from Partner, ROPA) to become pregnant. Furthermore, FIV allows patients to take preimplantation genetic diagnosis and this way reduce dramatically the risk of giving birth to children with genetic disorders.